(This story has been updated Tuesday with the latest figures on confirmed coronavirus cases and deaths from the disease, as well as information about Japan's use of a rapid testing system for the virus and other information).
As the coronavirus continues its rapid spread throughout China and the rest of the world, one thing is becoming increasingly certain: There’s a lot that’s still unknown about the newly discovered and sometimes deadly pathogen.
We have no idea how far and for how long it will spread or how many it will kill. We don't know when a vaccine will be created and even treatment is a guessing game. The virus' true origin and its effects on the human body also remain uncertain.
"We are learning about this as we go. My understanding of epidemiology of COVID19 is different this week than it was last week or two weeks ago,” said Dr. David N. Fisman, a professor of epidemiology at the University of Toronto, in an email to TheStreet. “Welcome to emerging infectious diseases: That's how it is."
As of Tuesday, the number of those infected rose to more than 72,400, the tally of the dead passed 1,860; the number of "severe" cases of the disease in China was around 11,000.
But as quickly as the infection and death count change, so do the headlines about the virus. Within just the past week, reports on the coronavirus – now officially dubbed COVID19 – blurred together, contradicted each other and confused many observers. Early in the week, we heard hopes of the virus hitting its “peak,” as it appeared that the increase in the number of infections and dead appeared to be slowing. A report in the Journal of the American Medical Association claimed that kids apparently weren’t affected by the virus and then researchers promised a potential vaccine could arrive in just 18 months. But why would it be needed? President Donald Trump claimed the coronavirus would be gone in the U.S. by April with the “heat” and that so far “we’re in great shape.”
But then came the flood of bad news. Reports landed that claimed the incubation period could be 10 days longer than previously believed. The World Health Organization labeled the virus Public Enemy No. 1. The tolls surged. Health officials told U.S. citizens to get ready for the virus to stick around for a while – past April, for sure – and China acknowledged by Friday night that health care workers accounted for 1,716 confirmed cases of the coronavirus. The number of deaths outside that country even increased, as patients in highly developed nations Japan, Taiwan and France died.
The only certainty – the only piece of reliable and consistent information – appeared to be the statics, the number of infections, the number of the dying.
But experts told TheStreet that even that data is not what it appears.
“I have said to some family members that looking at the numbers and reacting instantly is problematic,” said Dr. Fisman, whose research focuses include epidemiology and mathematical modeling of infectious diseases.
“It's like astronomy, where what you see isn't the star as it is right now, but the star as it was 10 years ago, if it's 10 light years away. Epidemics are like that: We are seeing information generated by last week's epidemic process … we can't see this week yet,” he said.
The reason why, he says, is that as far as doctors can tell, the disease has a seven or eight day “serial interval,” meaning the cases that happen on a given day reflect what was happening about a week prior.
“There are lots of lags built into public health surveillance systems,” Dr. Fisman said. “It's a problem, because this is scary, and the news cycle is 24 hours, but the virus is on virus time” – as in – “seven to eight days,” he said.
And, another expert, virologist Ian Mackay of the School of Medicine at the University of Queensland in Australia, notes that when it comes to the vast majority of data, China’s in control.
China, Mackay told TheStreet in an email, “holds all the data of importance.”
This data includes the number of non-hospitalized cases; how many people recovered but remained asymptomatic or only had mild and moderate symptoms; and when people first got infected.
Given all the continuously changing information and the unknowns surrounding how many cases truly exist makes predicting the path of the virus’ spread difficult, say experts.
“Only the Chinese can really predict where things are going,” said Mackay.
Are Unknown Cases Lurking in the U.S.?
Despite assurance from Trump this week that the virus would be out of our hair in a couple months, public health officials and others sounded increasingly concerned about how things would unfold here -- but still noted that the risk right now for the average American remains small.
“Most of the disease is in China, however, we can and should be prepared for this new virus to gain a foothold in the U.S.,” Dr. Nancy Messonnier of the Centers for Disease Control and Prevention told reporters earlier this week.
Later, the CDC’s director told CNN in more blunt terms that the pathogen will be here for a while.
"We don't know a lot about this virus," the agency’s director, Dr. Robert Redfield, told CNN's Dr. Sanjay Gupta. "This virus is probably with us beyond this season, beyond this year, and I think eventually the virus will find a foothold and we will get community-based transmission."
In the U.S. the official infection count remained at 15. But that figure appears increasingly in question, especially after it was discovered that tourists to Hawaii who recently returned to Japan reported they likely had the virus during their stay on the state, and it was reported early Monday that some 14 Americans evacuated from a cruise ship in Japan tested positive for the virus, with a top health official second-guessing the quarantine strategy of the long-docked ship Monday. "As it turned out, that was very ineffective in preventing the spread on the ship," Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, told USA Today.
Could there be hidden infections the U.S. that have not yet been found?
“There's no evidence of that,” said Dr. Henry I. Miller, who for many years worked at the Food and Drug Administration, including as an assistant to the commissioner for biotechnology, and currently is a senior fellow at the Pacific Research Institute, which is described as a “free-market think tank.”
But, Dr. Miller said in an email to TheStreet, the possibility that the virus has spread undetected here also “can’t be ruled out.”
“This is the cold and flu season, after all,” he said – the coronavirus can cause deadly pneumonia but also has symptoms that could be mistaken for a variety of common illnesses: fever, cough, sore throat and stomach problems such as diarrhea, making it hard to spot.
News over the weekend that a Japanese couple who visited Hawaii and became ill after staying there -- and even developed symptoms while there -- only adds to the likelihood that more infections will pop up.
“The Department of Health has been expecting and preparing for identifying a travel-related case in Hawaii because of the widespread outbreak in China and other areas of the world. The state is more than ready with aggressive control and prevention measures as we work closely with our medical community and response partners,” said the state's health director Bruce Anderson said in a statement.
The new case adds to the likelihood that infections will turn up in unexpected places, especially as researchers are not even certain whether the virus can become airborne, which would greatly increase its ability to infect people.
The Virus Is Virtually Everywhere Now
In just several weeks, the virus’ reach has now extended to dozens of nations outside of China, adding to the questions about what could happen next. At over 70 cases, Singapore alone now has as many cases as publicly announced in China just one month ago.
Looking at how the pathogen is taking root in that Asian nation specifically appears to show the coronavirus’ ability to take root outside of China, even in a nation with a robust health care system. Many of the coronavirus patients in Singapore had no prior travel to China and were infected locally, according to the nation’s Ministry of Health, which regularly releases updates on cases of the virus with great detail.
“I do think they are better at tracking each case, because of their determination to try and contain the virus at this stage, their experience and their expertise,” said Mackay.
Dr. Fisman also acknowledges that it’s possible that Singapore could be better at testing and tracking the coronavirus than other countries.
After all, the virus’ transmissiblilty, Dr. Fisman said, seems to be very similar to SARS. The Severe Acute Respiratory Syndrome-causing virus – a close cousin to the coronavirus now menacing the globe – ultimately had infected around 238 people in Singapore by December of 2003.
A similar, but apparently less pronounced, spread is also being seen in Japan, a nation also known both for its restrictive immigration and advanced health care. The archipelago has also spotted cases of infections from people with no history of travel, or clear connections to, China. By late in the week, it also recorded its first death from the virus: an elderly woman with no travel history to China whose son-in-law – also with no history of travel to China – became infected, too. Her son-in-law, a taxi driver, had said he only had Japanese passengers prior to his coronavirus symptoms emerging in late January, according to a report by Kyodo published in The Japan Times.
Those two wealthy nations have only seen scores of diagnoses, but what will happen in poor countries or in nations whose citizens lack adequate insurance – even with the advanced care found in the U.S., some 27 million people still lack coverage.
“Global disparities in public health infrastructure are a threat to everyone,” said Dr. Fisman. “If you don't like the fear and uncertainty associated with these outbreaks, you might want to support efforts to build sanitation, economic opportunities, and public health infrastructure in low income countries.”
Detection, Vaccination Hopes
What could help the U.S. strengthen its ability to spot new cases of the virus is the increasing availability of rapid-test kits, Dr. Miller said.
Earlier this month, the CDC did begin shipping laboratory test kits around the nation and beyond to help more quickly detect the coronavirus. But, even this step forward in the race to contain the coronavirus was tripped up when it found some of the kits it developed had glitches, giving “inconclusive” results. Other reports have questioned the accuracy of tests in general, too.
Japan, meanwhile, is preparing to distribute an advanced, rapid test system that can check specimens from 200 to 800 people at one time, as that nation is increasingly finding patients with the virus who had no known contact with or travel to Wuhan, according to the Asahi Shimbun.
Hope also arrived recently that a vaccine could be developed for the newly discovered coronavirus, when researchers proclaimed one could be possible within 18 months.
While several experts told TheStreet that the possibility exists to design a vaccine in that time frame, getting one ready to use for large populations seemed questionable.
“It could be ‘created’ in that time-frame,” said Miller, who has a long history at the FDA. But, he suggested he was skeptical it could be commercialized and available for safe use by then, pointing to a recent column he penned telling of the failures of a vaccine against swine flu virus in the 1970s that sickened hundreds and turned out to be unneeded.
“Because of the range of different types of vaccine technologies in the pipeline” that could bring a vaccine to trial much more quickly, said Mackay, the timeline seems reasonable. “However, we heard shorter figures earlier on, so take these latest numbers as wishful for now. The normal extent of safety testing must still be conducted on any new vaccines to ensure they don’t create more problems than they solve; there can’t be shortcuts on that.”
Aside from when a vaccine is available, some believe this is a good time to recognize – with the SARS virus now 17-years in the rear view mirror – that efforts should have already been underway to prepare to fight such viruses we know are bound to bite us one day.
“If the research funds spent on bat coronavirus surveillance research and bat coronavirius gain-of-function research instead been had spent on research on coronavirus vaccines and coronavirus antiviral drugs, there might now be effective countermeasures to combat outbreaks,” said Prof. Richard H. Ebright, the laboratory director at the Waksman Institute of Microbiology and a professor of chemistry and chemical biology at Rutgers University.
Rumors: Virus Engineered in Lab, Strikes Twice
The new virus is one of many coronaviruses that are commonly found in camels, bats and other animals. It's also included among the few that have become contagious among humans – including SARS and the far deadlier MERS, or Middle East Respiratory Syndrome. The Wuhan coronavirus is believed to have started its spread to people sometime in December in central China from a wild animal market, but even its origins have come under question.
Skepticism over China’s tradition of censorship and quashing dissent – and it’s handling of the past SARS outbreak – has helped fuel fears – and rumors – of all kinds. What is the true extent of the spread in China? Has the true death rate covered up? Was its supposed origin an honest theory or a fabrication?
Buried among the headlines this past week in traditional media such as the New York Times about disease-tracking reporters in China suddenly vanishing were conspiracy stories in other online sites that appeared to link the new coronavirus to Chinese military laboratories.
But Ebright, an expert in this area, says that any idea the coronavirus was genetically engineered in a lab is fiction.
“Absolutely nothing about the genome sequence of the virus suggests that the virus was engineered in a lab,” he told The Street. “The genome sequence of the virus indicates that its progenitor was the bat coronavirus RaTG13 or a closely related bat coronavirus.”
Because that bat coronavirus and other closely related bat coronaviruses are known to have been present in nature – such as in a cave in Yunnan province – the first human infection could have occurred as an accident of nature, Ebright said.
But he said, it is possible that the virus could have been leaked from a laboratory that was studying a virus, too.
“Because the bat coronavirus RaTG13 and closely related bat coronaviruses also are known to have been present in a lab (in the coronavirus collection at Wuhan Institute of Virology), the first human infection also could have occurred as a lab accident,” he said.
He noted that SARS, though first introduced to humans by nature, was also later reintroduced in a series of lab accidents.
The available data on the origin of human infection with the Wuhan coronavirus – whether from nature or a lab – Ebright said, “are consistent with either” cause.
Another shocking story that landed Saturday was that people could supposedly get re-infected with the virus, and the consequences were rapidly fatal.
The report, published in the Taiwan News and picked up by Zero Hedge, claimed that the second infection led quickly to heard failure in patients.
Virologist Mackay told TheStreet late Saturday night that while it’s not at all impossible to be infected by the same virus multiple times throughout life, it’s unlikely that people would end up experiencing the same degree of disease as they did the first time they were infected.
“This is due to the moderating effects of immunity,” said Mackay. “This new pronouncement suggests reinfection, but given reports of patients sometimes testing intermittently positive and negative, possibly because of the type of sample being chosen, I’m much more inclined to think this is a single occurrence of COVID-19 within which there are some negative results returned. This is yet another information bomb dropped without accompanying evidence for experts to review. Science can’t work like this; provide your results for peer review, or make it clear the information is only anecdotal.”
Kids Can’t Get Coronavirus, or Can They?
As doctors race to understand even basic aspects of the virus, still much is unknown. Even the CDC acknowledges that the “complete clinical picture with regard to COVID-19 is not fully understood.”
Several experts had publicly surmised that kids just don’t get the virus, or if they do, it doesn’t bother them.
If children were somehow immune, it could theoretically eliminate the likelihood of a vast set of scenarios about the potential spread of the virus. We can convince ourselves that adults will wash their hands, accurately describe symptoms, keep their fingers out of their mouths, seek care when needed, and avoid sharing food or sneezing and coughing on others. Expecting the same of children? Good luck.
“Cases in children have been rare,” wrote two physicians in a JAMA paper on Feb. 5 titled, “2019 Novel Coronavirus—Important Information for Clinicians.”
Mackay, however, expressed skepticism.
Though not a pediatrician, his virology work includes researching viruses that infect the respiratory tracts of children, such as influenza viruses, coronaviruses and the picornaviruses.
“I’m a virologist not a medical doctor, but there are still patterns. The low number of childhood cases maybe because they do have milder disease," he said, or "because they aren’t traveling as much (so not included among international travelers as often). It’s unlikely they are any less susceptible to infection, though. It may also be that contacts of known cases aren’t being tested, which may answer these questions.”
As another week begins, the story behind this coronavirus is likely to change again. The numbers will change. The discoveries will change. Perhaps even the global response will alter course. But one thing appears clear: The virus isn’t likely going away soon, not by April, at least.
This story has been updated. To contact the reporter, email adam.smith (at) thestreet (dot) com.